GEORGIA LAND CONSERVATION PROGRAM APPLICATION
Applicant Information
Project Name
Applicant Name Federal EIN
Contact Name and Title
Street Address P.O. Box
City, County, Zip
Phone Fax
Landowner Information
Current Landowner or Legal Designee
Contact Name and Title (if different from above)
Street Address P.O. Box
City, County, Zip
Phone Fax
1. Tract(s) Information
County
Land Lot(s) (if available) Acreage
GIS Coordinates (if available) Deed Reference (book and page)
Street Address of tract(s) (if available)
City, State, Zip
Please include a map or maps that clearly show the location and boundaries of applicable properties that are a part of this application
2. What are the unique or significant features of this tract and how does it meet GLCP’s ten program goals?
3. Briefly describe the past and current uses of the tract(s).
4. Describe the adjacent properties not included as part of this project, their current protection status if any, and their zoning or future land use.
5. How will the tract(s) be permanently protected - fee simple purchase or conservation easement? Describe the project outcome – who will own the property or hold the conservation easement and how will it be managed? (Note that properties protected via fee simple purchase shall be required to be permanently protected in a manner that ensures the land will remain forever in uses consistent with the goals of the program and provide for appropriate public use. Proposed conservation easements must be crafted in a manner that protects the conservation values in perpetuity and be held by a local, state, or federal jurisdiction or a nonprofit organization recognized under Section 501(c)3 of the Internal Revenue Code.
6. If through a conservation easement, summarize what reserved rights will be retained by the landowner and what rights will be extinguished and conveyed to the easement holder? Has the conservation easement been drafted and/or agreed to by the parties? If so, please provide a copy of the easement with the application.
7. Briefly summarize the status of the proposed real estate transaction. Has agreement on price been reached between the parties? Have the required appraisals, environmental hazard assessments or surveys been completed or initiated?
8. Describe any unique urgency or opportunity associated with the project at this time. Is there a chance that available funding or conservation values will be lost if funding is not awarded soon?
9. FINANCIAL INFORMATION: A financial review of every application will be conducted regardless of request for loan or grant funds.
Finance Contact Name and Title (if different than primary contact person)
Street Address P.O. Box
City, County, Zip
Phone Fax
10. FUNDING SUMMARY
Funding / AmountLoan amount requested (2% fee assessed at closing) / $
Grant amount requested / $
Estimated total fair market value of tract(s) or easement / $
Estimated real estate due diligence costs / $
Estimated total cost/value of project (including due diligence costs) / $
11. OTHER FUNDING SOURCES: List other non-GLCP/GEFA sources & amounts of funding for this land purchase and/or conservation easement purchase and related costs. This may be federal funds, other state funds, local funds, or private contributions. In addition to cash, contributions may include due diligence expenses (appraisal, survey and environmental hazard assessment costs); donations of land from a landowner; partial donations of land by a landowner (a discounted sale); and other contributable value pertinent to the real estate transaction needs of the property.
Source / Contact Name / Contact Number / Value / Amount / Date Received/ Time Restrictions$
$
$
$
$
Total / $
12. ATTACH OR EMAIL LAST FOUR YEARS OF APPLICANT’S AUDITS FOR LOAN APPLICATION OR MOST RECENT AUDIT FOR GRANT APPLICATION.
Fiscal Year End (FYE): Month/Date
Audits Submitted: FY______FY ______FY ______FY______
13. REPAYMENT SOURCE (FOR LOANS ONLY): List the Applicant’s planned repayment sources for GEFA debt service
Name of Fund Source / Revenue Item / Restricted for GEFA?QUESTIONS 14-16: FOUR YEARS OF GENERAL FUND DATA NEEDED FOR LOAN APPLICATIONS AND MOST RECENT YEAR OF GENERAL FUND DATA NEEDED FOR GRANT APPLICATION.
14. ECONOMIC INFORMATION: Complete the information for the LAST FOUR AUDITED FISCAL YEARS ( * GENERAL FUND ONLY)
FY __ / FY __ / FY __ / FY __Property Taxes Collected* / $ / $ / $ / $
Property Taxes Levied* / $ / $ / $ / $
Assessed Property Value* / $ / $ / $ / $
Taxable Full Value / $ / $ / $ / $
Number of Building Permit Applications
Unemployment Rate
Median Household Income / $ / $ / $ / $
Budgeted Revenues* / $ / $ / $ / $
Budgeted Identified Expenditures* / $ / $ / $ / $
Budgeted for Contingency* / $ / $ / $ / $
15. TOP EMPLOYERS: List the five current largest employers in the applicant’s jurisdiction (from largest to smallest based on the number of employees), their type of business and number of employees. If employment numbers include part-time and/or seasonal employees, please indicate.
Employer / Type of Business / Number of Employees1
2
3
4
5
16. LARGEST PROPERTY TAX PAYERS: List the applicant’s five current largest taxpayers (from highest to lowest, excluding private homeowners), their latest assessed valuation and type of business. Please list only those property owners which actually pay either property taxes or PILOTS (Payments in Lieu of Taxes). If any of these taxpayers receive a tax exemption, or if their assessment is currently disputed, please indicate.
Taxpayer / Type of Business / Assessed Valuation / Exemptioncheck if yes / Dispute
check if yes
$
$
$
$
$
17. FUTURE ECONOMIC INFORMATION: (For Loans Only) In the chart below, complete the information for the NEXT FOUR FISCAL YEARS AFTER LAST AUDITED YEAR (Includes Current Fiscal Year). Please list the sources of the forecast information and submit available documents.
Document Name Date
______
______
FY __ / FY __ / FY __ / FY __Property Taxes Expected To Be Collected* / $ / $ / $ / $
Property Taxes Planned To Be Levied* / $ / $ / $ / $
Planned Future Assessed Property Value* / $ / $ / $ / $
Future Expected General Fund Total Revenues / $ / $ / $ / $
Future Expected General Fund Total Expenditures (Including Annual Debt Service Payments) / $ / $ / $ / $
**Fund Source Name & Dedicated Annual Revenues / $ / $ / $ / $
Contingency Annual
Budget / $ / $ / $ / $
Future Annual Debt Service Payments for Bonds/Notes/ Capital Lease –IF NOT AMORTIZED IN LAST AUDIT / $ / $ / $ / $
Balances for Additional Planned Future Debt (OTHER THAN GEFA DEBT) (NOT IN MOST RECENT AUDIT) / $ / $ / $ / $
Expected Future Number of Building Permit Applications
( * GENERAL FUND ONLY; ** OTHER FUND SOURCE)
Source & Principal Balance of New Future Non GEFA Debt
Source: / $______ / $______ / $______ / $______
Source: / $______ / $______ / $______ / $______
Note: Incomplete applications cannot be fully reviewed:
The application review cycle takes approximately one hundred (100) days. Projects will be reviewed and scored upon receipt of a complete application, but award decisions will not be made by the Council until a qualifying appraisal has been submitted and approved and an agreement has been reached with the landowner. For conservation easements, easement terms must be negotiated with the landowner prior to initiation of an appraisal and approved by the GLCP prior to Council action.
To be signed by Applicant
I certify that I am authorized to sign this application on behalf of our governing body and all information is correct.
Signature of authorized official Print or type name
Date
To be signed by Current Landowner
The Georgia Land Conservation Program requires that the applicant submit the original signature of the current landowner or legal designee of the tract(s) for each of the following acknowledgements:
As the current Landowner or legal designee, I am aware that the Georgia Land Conservation Program will be solicited to secure full or partial funding for this project, and that any land or interest in land purchased with GLCP funds will become permanently protected conservation lands.
Signature of landowner or legal designee Print or type name
Date
In the case of a Conservation Easement, I, the landowner, am aware that annual site inspections will be required to ensure my land is being used in a manner consistent with the Conservation Easement agreement.
Signature of landowner or legal designee Print or type name
Date
Complete application package checklist: Please submit an electronic copy of the application and supporting materials in addition to at least one hard copy.
Is the application signed by an Authorized Official of the applicant community?
Is the application signed by the current landowner or legal designee?
Does the application package include supporting documentation for the project description, including but not limited to maps, historical data, site assessments, plat etc...?
Does the application package include a description outlining the long-range conservation and management of the land conservation project, including what conservation tools will be employed, what funding resources are available, and any not-for-profit or other conservation partners who will be involved in the project?
If for a low interest loan, does the application package include four years of Audits/CAFRs?
If for a low interest loan, does the application package include forecasts for the General Fund Revenues, Expenses and Debt Service Annual payments (If Not in Audit Amortization Schedules), and Future new/additional loan balances?